<!--
  ========================LICENSE_START=================================
  screenit-web
  %%
  Copyright (C) 2012 - 2020 Facilitaire Samenwerking Bevolkingsonderzoek
  %%
  This program is free software: you can redistribute it and/or modify
  it under the terms of the GNU Affero General Public License as published by
  the Free Software Foundation, either version 3 of the License, or
  (at your option) any later version.
  
  This program is distributed in the hope that it will be useful,
  but WITHOUT ANY WARRANTY; without even the implied warranty of
  MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE.  See the
  GNU General Public License for more details.
  
  You should have received a copy of the GNU Affero General Public License
  along with this program.  If not, see <http://www.gnu.org/licenses/>.
  =========================LICENSE_END==================================
  -->
<html xmlns:wicket="http://wicket.apache.org/">
<body>
<wicket:panel>
    <div class="form-horizontal">
        <h1>Beelden uploaden</h1>
        <form wicket:id="form">
            <fieldset>
                <div class="span8">
                    <div class="control-group">
                        <label class="control-label">Bestanden <i class="icon-asterisk icon-purple"></i></label>
                        <div class="controls">
                            <input wicket:id="fileUpload" type="file" multiple>
                            <span wicket:id="fileUploadProgress">[[ajax upload progressbar]]</span>
                        </div>
                    </div>

                    <div class="control-group">
                        <label class="control-label">Conclusie BI-RADS <i class="icon-asterisk icon-purple"></i></label>
                        <div class="controls">
                            <select wicket:id="conclusieBirads">
                                <option></option>
                            </select>
                        </div>
                    </div>

                    <div class="control-group value">
                        <label class="control-label">Conclusie eerste uitslag radiologie <i class="icon-asterisk icon-purple"></i></label>
                        <div class="controls">
                            <textarea wicket:id="conclusieEersteUitslagRadiologie"></textarea>
                        </div>
                    </div>
                    <div class="buttons">
                        <a href="" class="btn" wicket:id="annuleren">Annuleren</a>
                        <wicket:container wicket:id="geenBeschikbaar"></wicket:container>
                        <a href="" class="btn btn-primary" wicket:id="opslaan">Opslaan</a>
                    </div>
                </div>
                <div class="span4 pull-right">
                    <div wicket:id="paspoort"></div>
                </div>
            </fieldset>
        </form>
        <div wicket:id="dialog"></div>
    </div>
</wicket:panel>
</body>
</html>
